About this role
Description
-
Working under moderate direction, this role manages a book of specialty lines claims across the full claim lifecycle — from initial investigation through settlement and closure. The Claims Specialist conducts thorough investigations, recommends appropriate reserves, and resolves claims efficiently and cost-effectively within established authority limits for the line of business.
-
Responsibilities:
-
Analyzes, investigates, and evaluates losses to determine coverage and appropriate claim disposition
-
Documents claims and sets diaries for follow-up and key events using CMS
-
Establishes appropriate indemnity and expense reserves within assigned settlement authority, reviewing regularly to ensure adequacy; recommends reserve levels for claims exceeding authority
-
Prepares comprehensive claim reports as required
-
Identifies emerging claim trends and account or policy issues, communicating findings to management and underwriting
-
Manages the litigation process, including retaining counsel and overseeing case resolution
-
Ensures adherence to line-of-business litigation guidelines, including budget management, bill review, and payment
-
Actively participates in mediations and arbitrations within assigned settlement authority
-
Participates in the claims audit process
-
May support claims marketing efforts by engaging with brokers, risk managers, and reinsurers
-
Maintains required insurance adjuster licenses
-
If the selected candidate lives within 50 miles of a GRS office, then the selected candidate must come into the office two days/month.
Qualifications
-
Qualifications:
-
Bachelor's degree required; advanced degree preferred
-
5+ years of experience in claims handling, legal, or a related field
-
Strong working knowledge of claims handling concepts, practices, and techniques, including coverage issues and product line expertise
-
Solid understanding of insurance law and regulations across multiple jurisdictions
-
Excellent verbal and written communication skills
-
Strong negotiation skills, with the ability to resolve claims effectively within authority limits
-
Preferred Qualifications:
-
Experience handling HMO and Provider Excess Claims
Travel
10%